By Dr. Mercola
Constipation is one of the most common bowel problems, impacting up to 19 percent of the US population (no pun intended).1 It's defined as passing hard, dry stools that you have to strain to move, as well as having fewer than three bowel movements a week.
Constipation is uncomfortable, causing bloating, cramps, and a feeling of incomplete elimination. However, despite its ability to make you feel miserable, constipation is generally regarded as more of a nuisance than a real health threat.
This is a mistake, as chronic constipation left untreated can lead to fecal impaction,2 which is when hardened stool gets stuck in your intestines. Constipation has also been shown to increase your risk of colon cancer and has been implicated in diverticulosis and appendicitis.
Straining to have a bowel movement, which is common with constipation, is also not something to be taken lightly. This can lead to hemorrhoids, anal fissure (torn skin in your anus), and even rectal prolapse, in which a part of your intestine protrudes from your anus.
It can also be quite painful, leading to severe abdominal pain, which is likely one reason why emergency room (ER) visits for constipation have been on the rise.
ER Visits for Constipation Are on the Rise
From 2006 to 2011, there was a 42 percent increase in ER visits for constipation in the US – a significant rise that's far greater than the 22 percent increase in overall ER visits during the same period.3 The study's senior author, Dr. Anthony Lembo from Beth Israel Deaconess Medical Center in Boston, told Reuters:4
"Constipation is often thought of as not a serious disease – particularly among doctors. Patients complain about it but it's often not thought of as being medically that relevant."
The costs involved would suggest otherwise, however. From 2006 to 2011, costs of ER visits for constipation rose about 56 percent per patient, from $1,500 at the start of the study to $2,300 in 2011, after accounting for inflation. In all, about $1.6 billion was spent on ER care for constipation in 2011.5
This is an extremely high number, especially since constipation can usually be easily remedied with lifestyle changes. Ironically, one of the biggest hindrances to your success may be not realizing you're constipated in the first place.
Conventional medicine typically defines constipation as fewer than two or three bowel movements a week. But you should really be having one bowel movement a day, and preferably two or three. So if you are having anything less than one bowel movement a day, you should consider taking some constipation remedies.
What Causes Constipation?
Regular bowel movements are extremely important for your health because, without them, toxins accumulate and are recirculated in your bloodstream. If elimination is not regular and complete, the wastes will dry and become cemented to the walls of your colon.
Some of the common causes of constipation include laxative abuse, hypothyroidism, irritable bowel syndrome (IBS), and ignoring the urge to go. If you consistently ignore the urge to have a bowel movement – for instance, to avoid using a public toilet – eventually you may stop feeling the urge.
Certain medications, like antidepressants, antacids (like calcium), blood pressure medications, and iron supplements may also contribute to constipation, as can dehydration if you're not drinking enough pure water each day.
However, one of the primary causes of constipation has to do with your diet, particularly if you're eating one high in processed foods and low in fiber. One of the signs that a food is a natural source of fiber is that you must chew it a good number of times before swallowing. Processed foods, which basically melt in your mouth, are not going to give you the fiber your body needs.
Unless you regularly eat whole fruits and vegetables (along with nuts and seeds), you may be missing out on the healthiest forms of fiber available – and that could be a problem. It is actually because your body can't digest fiber that it plays such an important part in digestion. Soluble fiber, like that found in cucumbers and blueberries, dissolves into a gel-like texture, helping to slow down your digestion.
This helps you to feel full longer and is one reason why fiber may help with weight control. Insoluble fiber, found in foods like dark green leafy vegetables, green beans, celery, and carrots, does not dissolve at all and helps add bulk to your stool.
This helps food to move through your digestive tract more quickly for healthy elimination. Many whole foods, especially fruits and vegetables, naturally contain both soluble and insoluble fiber, which help to keep you regular, naturally.
Fiber Feeds Beneficial Gut Bacteria and Helps with Weight Loss
Fiber supplements have been shown to enhance weight loss among obese people,6 likely because fiber increases feelings of fullness. However, there's more to it. When microbes in your gut digest fiber, a short-chain fatty acid called acetate is released. The acetate then travels from your gut to your hypothalamus, where it helps signal you to stop eating.
In addition, fiber can shift the makeup of microbes in your gut in a very favorable direction. Research published in the American Journal of Clinical Nutrition, for instance, showed that people taking fiber supplements had more bacteroidetes than firmicutes.7
Bacteroidetes tend to be higher in lean people. Separate research found that obese individuals had about 20 percent more firmicutes and almost 90 percent less bacteroidetes than lean people.8 Firmicutes help your body to extract calories from complex sugars and deposit those calories in fat.
While it's becoming more widely known that supplementing with probiotics (or eating fermented foods) can favorably alter the makeup of your gut microflora, this new research is important because it shows how dietary fiber also plays a role. Hannah Holscher, a University of Illinois postdoctoral researcher, told Rodale News:9
"We're hoping this study helps people realize that diet—what you eat every day—does affect the bacteria in your gut. We saw these dramatic shifts in bacterial populations with fiber supplementation, but then those shifts went away when people stopped using the supplements."
Fermented Foods Are Important to Make Your Fiber Work with You, Not Against You
The human digestive system is not designed to break down fiber. Instead, it ends up undigested in your bowel, where the majority of your gut flora resides. If your gut flora is healthy, i.e. dominated by beneficial probiotic species, then these microbes will feed on the fiber and proliferate.
However, if your gut is filled with pathogenic bacteria and/or yeast and fungi, fiber may actually make your symptoms worse, as it is a non-specific growth factor for intestinal bacteria and does not discriminate between pathogenic and beneficial bacteria.
So, if your bowel is predominantly dominated by pathogenic microbes, they will feed on fiber and proliferate, making whatever health problems you have worse. Increasing fiber from vegetables is incredibly important if you're constipated, as I'll explain below, but so, too, is making sure you're introducing that fiber to a healthy gut environment.
The key to doing this is to reduce your intake of excess sugar while adding naturally fermented foods into your diet, such as fermented vegetables and raw grass-fed kefir (if you tolerate dairy).
You can also add a probiotic supplement if you suspect you're not getting enough beneficial bacteria from your diet alone. Probiotics have even been shown to help relieve constipation among one particularly constipation-prone population – pregnant women.10
Vegetables Are One of the Best Sources for Your 32 Grams of Fiber a Day
Assuming your gut is generally healthy, I believe most people need upwards of 32 grams of fiber a day. Most Americans get nowhere near this amount, which could easily contribute to chronic constipation. As the New York Times reported:11
"...the current average fiber intake in the United States is about 13 grams a day for women and 17 for men. Increasing these amounts by seven grams a day would bring them close to the recommended levels of 21 to 25 grams for women and 30 to 38 for men.
'Seven grams a day increase is an achievable goal…' 'You're talking about... increasing vegetable and fruit by two portions a day.'"
If your diet could use more fiber, resist the urge to fortify it with whole grains. Grains actually contain anti-nutrients that may damage your health, as well as sticky proteins like gluten (literally, Latin for "glue") in the prolamine class, which are highly constipating to some individuals. If you're constipated, try removing all sources of glutinous, prolamine-containing grains from your diet (the most common sources are wheat, barley, rye, and spelt). Instead, focus on eating more vegetables, nuts, and seeds. The following whole foods, for example, contain high levels of soluble and insoluble fiber.
Chia seeds Berries Vegetables such as broccoli and Brussels sprouts Root vegetables and tubers, including onions and sweet potatoes Almonds Psyllium seed husk, flax, and chia seeds Green beans Cauliflower Beans Peas
Organic whole husk psyllium is another simple, cost-effective way to add more fiber to your diet. Taking it three times a day could add as much as 18 grams of dietary fiber (soluble and insoluble) to your diet, which brings you quite close to the recommended minimum of 20 grams a day. Ideally, you'll want to get around 30-32 grams per day for optimal health, so you'll want to use psyllium in addition to a healthy, veggie-rich diet. Please keep in mind that psyllium is a heavily sprayed crop, which means many sources are contaminated with pesticides, herbicides, and fertilizers.
For this reason, be sure to ONLY use organic psyllium husk, and make sure it's 100% pure. Many supplement brands use synthetic or semi-synthetic active ingredients that do not contain psyllium, such as methylcellulose and calcium polycarbophil. Some brands even add sweeteners and other additives, which you're better off avoiding. As an added bonus, soluble fibers such as psyllium are prebiotics that help nourish beneficial bacteria. These beneficial bacteria in turn assist with digestion and absorption of your food, and play a significant role in your immune function.
Policosanols on Vegetables Are Important for Regularity
Aside from fiber, another reason why vegetables, and green leafy vegetables, in particular are so good for regularity has to do with waxy alcohols called policosanols, which coat the leaves. Policosanols act as a natural waterproofing agent for plants and when you eat them they help speed the passage of food through your gastrointestinal (GI) tract.
As mentioned, green leafy vegetables are an excellent source of policosanols, but if you're eating mostly processed varieties, you're probably not getting them. Processing often destroys the natural policosanols from the food you eat. These healthy substances are also found in foods such as peanuts, pomegranate seeds, grapeseed oil, and perilla seeds and oil, as well as in supplement form if you're not getting enough from dietary sources.
Are You Exercising? It Can Help You 'Go'
We've covered the importance of nourishing a healthy gut environment with beneficial bacteria, fermented foods, and sugar avoidance, while eating plenty of fiber-rich vegetables. This is a large part of the picture, but it's not the whole thing. Exercise is also important for regularity, in part because your abdominal and intestinal muscles work together to help move your bowels. If these muscles are weak, you'll have a harder time with bowel movements. In addition, movement helps stimulate circulation and intestinal function, causing your bowels to move properly.
Squatting Can Help if You're Constipated
The last thing most people think about when using the bathroom is position, but this can significantly impact the ease with which you eliminate and even increase your risk of bowel and pelvic problems, including constipation, hemorrhoids, and more. Most of you reading this probably sit to evacuate your bowel, but this requires you to apply additional force (straining), which has some unwanted biological effects, including a temporary disruption in cardiac flow.
Sitting on a modern toilet is designed to place your knees at a 90-degree angle to your abdomen. However, the time-honored natural squat position (which is still used by the majority of the world's population) places your knees much closer to your torso, and this position actually changes the spatial relationships of your intestinal organs and musculature, optimizing the forces involved in defecation.
Squatting straightens your rectum, relaxes your puborectalis muscle, and allows for complete emptying of your cecum and appendix without straining, which prevents fecal stagnation and the accumulation of toxins in your intestinal tract. It is instructive that non-westernized societies, in which people squat, do not have the high prevalence of bowel disease seen in developed nations; in some cultures with traditional lifestyles, these diseases are uncommon or almost unknown.
If you have trouble with bowel movements, especially constipation, I urge you to give the squat position a try. Squatting does involve strength and flexibility that adults tend to lose over time (but children have naturally). Special toilets and stools that get your body into a more "squatty" position can help you get closer to the ideal even if you've been sitting for decades.
Use Extreme Caution When Considering Laxatives
If you're constipated, it may be tempting to turn to an over-the-counter laxative for relief. However, they must be used with extreme caution. Last year, the US Food and Drug Administration (FDA) released a warning following 13 deaths (12 adults and one child) that occurred after use of OTC saline laxatives (including brand name Fleet and others).12 The products contain the active ingredient sodium phosphate, which draws water into your bowel to help soften your stool, allowing it to pass easier.
However, if too much is taken, the laxatives can lead to dehydration and abnormal levels of electrolytes in your blood, which can cause kidney damage, heart problems, and death. Another crucial reason why laxatives are NOT a good option is that your body may become dependent on them. This is especially true with stimulant laxatives (such as brand name Exlax), which work by increasing the contraction of muscles in your intestines. This risk also applies to senna or cassia laxatives, which are frequently marketed as "natural."
These laxatives may decrease your colon's ability to contract and over time may damage your large intestine's nerves, muscles, and other tissues. The cumulative lifetime use of commercial laxatives has even been associated with increased risk of colon cancer.13 For these reasons, and because constipation is usually easy to remedy naturally, laxatives should be avoided at all cost and used only as a last resort. If you absolutely must use a laxative, make sure it is used for only a very short period of time.
You could also try a magnesium supplement as a short-term alternative, as one of the ways to determine proper dosing is the "bowel test." You know you have too much magnesium when your stools become loose, which is often a pleasant "side effect" for those with constipation. Magnesium deficiency may also manifest as constipation, so you might be treating the underlying cause as well. Do not, however, use an excess of magnesium for regularity purposes long-term, as this can upset your calcium/magnesium ratio and cause other problems.